학술논문
코로나 대유행 이후 응급실에 내원한 발열 환자의 진료과정 및 이에 따른 예후 비교 : 코로나 대유행 전후 비교연구 / Comparison of the clinical process and outcomes in patients with fever who visited the emergency department before and after coronavirus infection 2019 outbreak
Document Type
Dissertation/ Thesis
Author
Source
Subject
Language
English
Abstract
목적: 코로나바이러스-2019 감염증 (COVID-19) 대유행은 응급실 진료에 영향을 미쳤다. 발열 등이 확인된 의심 환자의 진료 시에는 바이러스 전파를 예방하기 위해 격리실과 개인 보호 장비를 사용해야 한다. 이로 인하여 환자와 처음 대면 시까지 시간이 지연되므로 응급실에서 체류 기간이 증가할 것이다. 이에 이 연구에서는 COVID-19 기간과 COVID-19 이전 기간 사이의 응급실 내 체류 시간 및 진료 진행과정에서의 지연을 비교하는 것을 목표로 했다. 또한, 발생한 진료 지연이 환자 결과에 영향을 미치는지 여부를 평가하고자 했다.방법: 이 연구는 서울에 위치한 1개 대학 병원에서 후향적으로 진행이 되었다. 발열 환자는 2020년 3월부터 2020년 8월까지의 " COVID-19"과 2019년 3월부터 2019년 9월까지의 "COVID-19 이전 기간"으로 나누어 비교되었다. 모집된 환자를 대상으로 초기 진단 검사 (실험실 테스트, 방사선 촬영), 특정 진단 검사 (컴퓨터 단층 촬영), 치료 과정 (항생제)을 포함한 전반적인 응급실 내 체류시간과 각각의 개별 시간 변수를 비교했다. 병원 입원과 환자 데이터 사이의 연관성을 확인하기 위해 로지스틱 회귀 분석이 수행되었다.결과: 우리는 COVID-19 이전 기간의 발열환자 931명과 COVID-19 기간 749명의 환자를 대상으로 연구를 진행하였다. 발열 환자는 COVID-19 기간 동안 응급실 내 체류시간이 더 긴 것으로 나타났다. (COVID-19 이전 기간: 207.7±102.7분, COVID-19 기간: 223.5±119.4분, p=0.004). 실험실 검사와 방사선 촬영을 수행하는 총 시간의 비교에서는 모두 통계적으로 유의미한 차이가 있었으며 특히 환자가 응급실에 도착한 시점부터 첫 오더를 낼 때까지 두 기간 간에 상당한 차이를 보였다. 결과적으로 항생제가 투여가 COVID-19 기간에 더 늦게 이루어지는 것을 알 수 있었다. (COVID-19 이전기간: 195.8±103.3분 vs. COVID-19 기간: 216.9±108.4분, p = 0.003) 병원 입원예측을 위한 로지스틱 회귀 분석에서는 응급실 내 체류시간이 두 기간 모두 독립적인 요인으로 식별되었다.결론: COVID-19 시대에는 격리실 사용 및 개인보호구 착용 등의 이유로 발열 환자 진료 시 최초 대면하여 오더를 내는 시간의 지연이 발생하였으며, 이것이 응급실 내 체류시간의 증가 및 치료의 지연을 불러왔다.
Background and Objectives: The coronavirus infection 2019 (COVID-19) pandemic has affected the emergency department (ED) management. Its viral transmission necessitates the use of isolation rooms and personal protective equipment for treating suspected patients, such as those with fever. This delays the time until the first encounter with the patients, thereby increasing the length of stay (LOS) in the ED. We aimed to compare delays in the ED LOS and clinical processes between the COVID-19 period and pre-COVID-19 period. Moreover, we intended to evaluate if the aforemen-tioned delay affected patient outcomes. Materials and Methods: We conducted a single-center, ret-rospective study in Korea. Patients with fever were compared between the “COVID-19 period” from March 2020 to August 2020 and the “pre-COVID-19 period” from March 2019 to September 2019. We compared the overall ED LOS and individual time variable, including initial diagnostic tests (laboratory tests, radiography), specific diagnostic test (computed tomography), and treatment processes (antibiotics). A logistic regression analysis was conducted to identify the association between hospital admission and patient data.Results: We enrolled 931 and 749 patients during pre- and COVID-19 periods, respectively. Patients with fever remained in the ED for a longer duration during the COVID-19 period (pre-COVID-19:207.7±102.7 min vs. during COVID-19: 223.5±119.4 min, p=0.004). The total time for performing laboratory tests and radiography displayed significant differences between the two periods, particularly from the time of patient arrival in the ED to the time of issuing the order. The time until antibiotic administration was delayed in the COVID-19 period (pre-COVID-19:195.8±103.3 min vs. during COVID-19: 216.9±108.4 min, p=0.003). The lo-gistic regression analysis for hospital admission identified ED LOS as an independent factor in both periods. Conclusions: The delay until encountering patients with fever resulted in longer ED LOS during the COVID-19 period; however, it possibly did not increase the hospital admission rates.
Background and Objectives: The coronavirus infection 2019 (COVID-19) pandemic has affected the emergency department (ED) management. Its viral transmission necessitates the use of isolation rooms and personal protective equipment for treating suspected patients, such as those with fever. This delays the time until the first encounter with the patients, thereby increasing the length of stay (LOS) in the ED. We aimed to compare delays in the ED LOS and clinical processes between the COVID-19 period and pre-COVID-19 period. Moreover, we intended to evaluate if the aforemen-tioned delay affected patient outcomes. Materials and Methods: We conducted a single-center, ret-rospective study in Korea. Patients with fever were compared between the “COVID-19 period” from March 2020 to August 2020 and the “pre-COVID-19 period” from March 2019 to September 2019. We compared the overall ED LOS and individual time variable, including initial diagnostic tests (laboratory tests, radiography), specific diagnostic test (computed tomography), and treatment processes (antibiotics). A logistic regression analysis was conducted to identify the association between hospital admission and patient data.Results: We enrolled 931 and 749 patients during pre- and COVID-19 periods, respectively. Patients with fever remained in the ED for a longer duration during the COVID-19 period (pre-COVID-19:207.7±102.7 min vs. during COVID-19: 223.5±119.4 min, p=0.004). The total time for performing laboratory tests and radiography displayed significant differences between the two periods, particularly from the time of patient arrival in the ED to the time of issuing the order. The time until antibiotic administration was delayed in the COVID-19 period (pre-COVID-19:195.8±103.3 min vs. during COVID-19: 216.9±108.4 min, p=0.003). The lo-gistic regression analysis for hospital admission identified ED LOS as an independent factor in both periods. Conclusions: The delay until encountering patients with fever resulted in longer ED LOS during the COVID-19 period; however, it possibly did not increase the hospital admission rates.